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2018 DIGILAW 1100 (GUJ)

Chandrakant Kantilal Dave v. State of Gujarat

2018-09-18

A.S.SUPEHIA

body2018
JUDGMENT : A.S. SUPEHIA, J. 1. The present writ-petition is filed by a Senior Citizen, claiming his medical reimbursement of Rs. 1,76,000/- who suffered from a heart-attack and had to undergo bypass surgery in an emergent situation. 2. The present petitioner underwent Coronary Artery Bypass Surgery (C.A.B.G.) on 13-6-2011. The hospital in which he took the aforesaid treatment had issued medical bill of Rs. 1,76,000/-. The State Government only sanctioned an amount of Rs. 66,000/- against the package bill of Rs. 1,76,000/- incurred by the present petitioner. The petitioner, thereafter, issued a notice to the respondent-authorities on 5-5-2012 to reimburse him an amount of Rs. 1,76,000/-, but no decision was taken on the aforesaid notice. Since, the respondent-authorities did not reimburse the outstanding amount, the petitioner was constrained to approach this Court. 3. Mr. Gogia, learned Advocate for the petitioner has invited attention of this Court to the Resolution dated 9-9-2005. He has submitted that the present petitioner undertook the treatment at Sal Hospital which also figures in the list of approved hospitals in the aforesaid resolution. He has submitted that the petitioner underwent the treatment in the year 2011, whereas the respondent-authorities while placing reliance on the aforesaid Resolution dated 9-9-2005 has reimbursed the amount of Rs. 66,000/- as mentioned therein. He has submitted that the State Government is required to revise the policy as per prevalent charges of the hospital mentioned therein. He has submitted that it is not the case of the respondent-authorities that the petitioner has concocted the aforesaid medical bill of Rs. 1,76,000/-. 4. In support of his submissions, reliance is placed by learned Advocate Mr. Gogia upon the decisions of Apex Court in the case of K.P. Singh v. Union of India, reported in 2001 (10) SCC 167 and in the case of Shiv Kant Jha v. Union of India, reported in 2018 (3) SLR 328 (SC). He has submitted that as per the observations made by the Apex Court, the State Government is bound to revise the rates from time to time so that beneficiary receive the reimbursement as per the expenses incurred by the concerned employee. He has submitted that in the case of Shiv Kant Jha (supra) the Apex Court has directed the respondents to reimburse the amount, as claimed by the claimant, even though, treatment was taken by him from the hospital which was not approved by the State Government. He has submitted that in the case of Shiv Kant Jha (supra) the Apex Court has directed the respondents to reimburse the amount, as claimed by the claimant, even though, treatment was taken by him from the hospital which was not approved by the State Government. 5. Learned Advocate for the petitioner has also relied upon the judgment dated 26-3-2012, passed by this Court in Special Civil Application No. 624 of 2002 (J.V. Shah v. State of Gujarat) for claiming interest. 6. In response to the submissions advanced by Mr. Gogia, learned Advocate for the petitioner, Mr. Utkarsh Sharma, learned Assistant Government Pleader for the respondent-authorities has submitted that as per the policy of the State Government promulgated vide Resolution dated 9-9-2005, the petitioner is entitled to an amount of Rs. 66,000/- only. The attention of this Court is drawn to the Condition No. 1, envisaged in the aforesaid resolution which signifies that an employee/pensioner would be entitled to minimum rate, as prescribed in the common package or as per the rate prescribed in the appendix to the aforesaid resolution. He has stated that present petitioner has been paid an amount of Rs. 66,000/- towards reimbursement, as prescribed in the aforesaid appendix. 7. As regards the submissions advanced by Mr. Gogia, learned Advocate for the petitioner, Mr. Utkarsh Sharma, learned Assistant Government Pleader has submitted that the petitioner is not entitled for an amount of Rs. 1,76,000/- since he has not challenged the aforesaid Resolution dated 9-9-2005. 8. In the present case, it is undisputed fact that the petitioner has undergone Bypass Surgery at the age of 74 years. The petitioner having fallen seriously ill, was advised to for immediate and urgent bypass surgery. The petitioner, under medical advice, was taken to the Sal Hospital, Ahmedabad for such surgery/treatment wherein considering the seriousness of the petitioner, he was operated for Coronary Artery Bypass Surgery (C.A.B.G.) and remained as indoor patient in the hospital for the period from 13-6-2011 to 23-6-2011. For the said treatment and surgery, the Sal Hospital has issued total package bill of Rs. 1,76,000/-. The State Government, after following Resolution dated 9-9-2005 has reimbursed the amount of Rs. 66,000/- in favour of the petitioner. For the said treatment and surgery, the Sal Hospital has issued total package bill of Rs. 1,76,000/-. The State Government, after following Resolution dated 9-9-2005 has reimbursed the amount of Rs. 66,000/- in favour of the petitioner. Thus, the petitioner, who had undergone surgery in the year 2011, has been paid the reimbursement as per the policy of the year 2005 which is 6 years prior to the date of his surgery. It is also reported that the aforesaid rates are not yet revised and the same are prevalent as on date. The Apex Court in the judgment rendered in the case of K.P. Singh (supra) has observed in Paragraph No. 6 that: "6. The last grievance, and it is of some note, is that a beneficiary of the Scheme will receive reimbursement only at the rate approved by the C.G.H.S.. regardless of the fact that in his particular town or city there are only private hospitals and no Government Hospital; there is, therefore, no option to him, but to enter a private hospital for such treatment. It is also submitted that the approved rates are not updated by the C.G.H.S. from time to time, so that what the beneficiary receives by way of reimbursement, can be substantially less than the cost that has actually been incurred upon his hospitalization while there is, we think, merit in the submission, it is not for us to dictate what should be done. We direct the Union of India, immediately to consider this aspect and give appropriate directions thereon. It would clearly be appropriate for it to update its approved rates on an annual or, at least, bi-annual basis." 9. The Apex Court though has observed that there is merit in the submissions of revising the rates time to time, however, ultimately directed the Union of India to consider this aspect and gave appropriate directions thereon. 10. The Apex Court, in the recent decision, in the case of Shiv Kant Jha v. Union of India, reported in 2018 (3) SLR 328 (SC) has observed thus: "(13) It is a settled legal position that the Government employee during his life-time or after his retirement is entitled to get the benefit of the medical facilities and no fetters can be placed on his rights. It is acceptable to common sense, that ultimate decision as to how a patient should be treated vests only with the doctor, who is well-versed and expert both on academic qualification and experience gained. Very little scope is left to the patient or his relative to decide as to the manner in which the ailment should be treated. Speciality Hospitals are established for treatment of specified ailments and services of doctors specialized in a discipline are availed by patients only to ensure proper, required and safe treatment. Can it be said that taking treatment in Speciality Hospital by itself would deprive a person to claim reimbursement solely on the ground that the said Hospital is not included in the Government Order. The right to medical claim cannot be denied merely because the name of the hospital is not included in the Government Order. The real test must be the factum of treatment. Before any medical claim is honoured, the authorities are bound to ensure as to whether the claimant had actually taken treatment and the factum of treatment is supported by records duly certified by doctors/hospitals concerned. Once, it is established, the claim cannot be denied on technical grounds. Clearly, in the present case, by taking a very inhuman approach, the officials of the C.G.H.S. have denied the grant of medical reimbursement in full to the petitioner forcing him to approach this Court." 11. In the case before the Apex Court, the employee had taken treatment in a hospital which was not at all recognized or approved by the State Government or it was not included in the Government Order. The Apex Court has observed thus: "(14) This is hardly a satisfactory state of affairs. The relevant authorities are required to be more responsive and cannot be in a mechanical manner deprive an employee of his legitimate reimbursement. The Central Government Health Scheme (C.G.H.S.) was propounded with a purpose of providing health facility scheme to the Central Government employees so that they are not left without medical care after retirement. It was in furtherance of the object of a Welfare State, which must provide for such medical care that the scheme was brought in force. In the facts of the present case, it cannot be denied that the writ petitioner was admitted in the abovesaid hospitals in emergency conditions. It was in furtherance of the object of a Welfare State, which must provide for such medical care that the scheme was brought in force. In the facts of the present case, it cannot be denied that the writ petitioner was admitted in the abovesaid hospitals in emergency conditions. Moreover, the law does not require that prior permission has to be taken in such situation where the survival of the person is the prime consideration. The doctors did his operation and had implanted C.R.T.D. device and have done so as one essential and timely. Though, it is the claim of the respondent-State that the rates were exorbitant whereas the rates charged for such facility shall be only at the C.G.H.S. rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry, it also cannot be denied that the petitioner was taken to hospital under emergency conditions for survival of his life which requirement was above the sanctions and treatment in empaneled hospitals." 12. The Apex Court has noted the submissions advanced by the respondent-State that "the rates were exorbitant whereas the rates charged for such facility shall be only at the C.G.H.S. rates and that too after following a proper procedure given in the Circulars issued on time to time by the concerned Ministry". The Apex Court has observed that the petitioner was taken to hospital under emergency conditions for survival of his life which requirement was above the sanctions and treatment in empaneled hospitals. The Apex Court directed the respondent-State to pay balance amount to the writ petitioner towards his medical reimbursement. 13. In light of the law enunciated by the Apex Court, this Court is of the opinion that the present petitioner, who is now aged about 82 or 83 years cannot be relegated back to the respondent-authorities to re-examine his case for medical reimbursement. 14. In light of the observations made by the Apex Court, the respondent-authorities shall pay the balance amount of Rs. 1,10,000/- along with interest of 9% from the date of filing of present writ petition to the present petitioner within a period of four weeks from the date of receipt of the copy of the present order. 14. In light of the observations made by the Apex Court, the respondent-authorities shall pay the balance amount of Rs. 1,10,000/- along with interest of 9% from the date of filing of present writ petition to the present petitioner within a period of four weeks from the date of receipt of the copy of the present order. The State Government is also directed to further consider the aspect of updating their approved rates from time to time and issue appropriate directions thereon on an annual basis. With the aforesaid observations and directions, present writ-petition is allowed and is accordingly, disposed of. No order as to cost. Rule is made absolute.